Intense scratching can infect the skin, turning dry patches into painful weeping sores. If scratching continues for years, skin can thicken and become leathery.
In babies, eczema often appears on the cheeks, scalp, neck, forehead and forearms. In children and adults, it is most often found inside the elbows, on the backs of knees, and on the ankles, face and neck. However, eczema can develop anywhere on the body.
This chronic condition affects about 20 per cent of the population, and often runs in families. It actually includes a variety of skin conditions, with atopic dermatitis being the most common. The terms eczema and atopic dermatitis are often used interchangeably. ‘Atopic’ refers to diseases that involve an inherited tendency toward allergic conditions like asthma or hay fever. ‘Dermatitis’ means inflammation of the skin.
Still, this condition is not an allergy. Those with one atopic condition like asthma are more likely to develop another such as eczema. Up to half of children with asthma may also have eczema.
Breastfeeding can help children as it protects against the condition. In families where a sibling or a parent has eczema, breastfeeding is strongly encouraged.
The exact cause of atopic dermatitis is not known. It may be an overactive response by the immune (defence) system to irritants or ‘triggers.’ Triggers activate cells in the skin that produce inflammation. These cells release chemicals and cause itchiness and redness. Eczema triggers include heat, dryness, stress, sweating, coarse fabrics, soap, laundry detergent, dust mites, and even the common cold.
Since triggers are different for each person, they can be hard to identify. Studies have shown that foods like peanuts, eggs, soy or fish may trigger the condition, especially in very young children. In addition to skin problems, nausea, vomiting, diarrhea, abdominal cramping, congestion, sneezing and wheezing can appear. In this case, the doctor may suggest skin allergy testing.
Triggers cause eczema to flare up. Flares often alternate with remissions, periods when skin improves or clears altogether.
Eczema usually appears before age five. Most babies with eczema improve by age two, and up to 40 per cent outgrow it by young adulthood. However, it is impossible to predict who will outgrow the disease. Untreated, eczema can affect a child’s sleep and learning.
If you suspect eczema, it is important to get medical advice. Your family doctor is trained to diagnose and treat eczema. If it is severe, you may be referred to a dermatologist who specializes in treating skin problems. Effective treatment can control the number and intensity of flares.
Avoiding triggers and providing additional moisture often relieves the condition. The first level of treatment involves simple measures you can put into practice yourself.
If necessary, medication can be added to the strategies you already use to combat eczema.
In an acute flare situation, or to prevent a flare, your doctor may prescribe a corticosteroid cream or ointment to reduce inflammation. These medications are effective and safe when used as directed.
This new class of medications is now available to treat eczema. One is called tacrolimus ointment (Protopic™), the other pimecrolimus cream (Elidel™). Calcineurin inhibitors work by changing immune system response in the skin. While effective, these medications are expensive. Your doctor may choose these drugs if eczema is resistant to corticosteroid treatment or to avoid the skin-thinning side effects. Be especially careful to shield skin from the sun when calcineurin inhibitors are being used.
If severe eczema is resistant to topical treatments (medications applied directly to the skin), oral medication may be prescribed. The most common medications taken by mouth are antihistamines, which can help relieve severe itching at night.
Those with eczema are more at risk of developing skin infections. In this case, antibiotics may be used along with eczema treatment.
Eczema, or atopic dermatitis, is a chronic condition. Do not let it control your life or that of your child. Talk to your doctor and learn how to successfully manage eczema.